Reversing a Vasectomy: What Vasovasostomy Can — and Cannot — Do

A vasectomy is designed as a permanent method of contraception. Still, life sometimes changes — and some men eventually ask: can a vasectomy actually be reversed? The honest answer is nuanced. Reversal is technically possible, but it does not guarantee that fatherhood will follow. This article explains what a vasovasostomy is, when it can make sense, and what realistic outcomes you should expect.

What a vasectomy actually does

During a vasectomy, both vas deferens (the tubes that carry sperm) are cut and sealed. Sperm produced by the testicles can no longer reach the ejaculate. Hormone production, libido and erectile function remain unchanged — only the sperm transport is interrupted.

Because of this, a vasectomy should always be considered a long-term decision, made only after family planning is complete. You can read more about the procedure (including the modern no-scalpel technique) on our vasectomy in Vienna page.

What is a vasovasostomy?

A vasovasostomy is the microsurgical reconnection of the previously cut ends of the vas deferens. Because the inner diameter of the duct is smaller than one millimeter, the operation is performed under a surgical microscope and requires highly specialised training.

In some cases — especially when years have passed since the vasectomy — a simple vasovasostomy is no longer enough. Pressure can build up in the epididymis over time, leading to a secondary blockage. In that situation a more complex procedure is needed: a vasoepididymostomy, where the vas deferens is connected directly to the epididymis.

What success rates can you realistically expect?

Obstructive Interval	Patency Rate	Pregnancy Rate	References
3 years	97 %	76 %	[1–2]
3–8 years	88 %	53 %	[1–2]
9–14 years	79 %	44 %	[1–2]
≥ 15 years	71 %	30 %	[1–2]

References: [1] Herrel LA, Goodman M, Goldstein M, Hsiao W. Outcomes of Microsurgical Vasovasostomy for Vasectomy Reversal: A Meta-Analysis and Systematic Review. Urology. 2015. — [2] Vasectomy Reversal. Fertility and Sterility. 2006. Guideline.

Two distinct numbers always have to be separated:

• Patency — whether sperm reappear in the ejaculate after surgery.
• Pregnancy rate — whether a pregnancy actually occurs. This is always lower than patency because partner age and female fertility play a major role.

Why does the success rate fall over time?

After a vasectomy the testicles continue to produce sperm, but those sperm can no longer be transported. Over the years this can:

• create a secondary obstruction in the epididymis,
• and in some men trigger anti-sperm antibodies, an immune response to stagnant sperm.

Both effects can reduce sperm motility and fertilising capacity even when the ducts have been successfully reopened. That is why surgical patency is not the same as a successful pregnancy.

When does a reversal make sense?

A vasovasostomy can be a reasonable option in situations such as:

• a new partnership and a renewed wish for children,
• a vasectomy performed at a very young age that is now regretted,
• the loss of a child,
• a relatively short interval since the vasectomy.

It is not a routine operation. The decision should always be based on a thorough urological evaluation, a realistic discussion of expected outcomes, and — where relevant — a fertility check on the female partner.

What does a vasectomy reversal cost?

A vasovasostomy is a specialised microsurgical procedure performed at dedicated andrology or microsurgery centres. In Austria, costs typically range between € 2,500 and € 5,000, depending on the centre and the complexity of the case. Statutory health insurance usually does not cover the procedure; some private supplementary insurances may reimburse part of it.

If you are still in the planning phase of a vasectomy, our overview of vasectomy costs can help you put the numbers in context.

Alternative: surgical sperm retrieval and assisted reproduction

If a reversal is unlikely to succeed, or simply not desired, there is another path: surgical sperm retrieval (such as TESA or MESA) combined with IVF / ICSI. Sperm are obtained directly from the testicle or epididymis and used in assisted reproduction.

This bypasses the blocked vas deferens entirely. Outcomes then depend mostly on sperm quality and on the partner’s age and fertility. The approach is more expensive than a reversal and requires a reproductive medicine centre, but for some couples it is the more pragmatic option.

Frequently asked questions

Is a vasectomy reversible?

Technically, yes — a vasectomy can be surgically reversed. However, full restoration of fertility is never guaranteed and the chances generally decrease the longer the interval since the original operation.

When is the best time to undergo a reversal?

Earlier is better. The best results are typically reported when the reversal is performed within the first few years after the vasectomy.

How long does the operation take?

A vasovasostomy usually takes around 2 to 4 hours, depending on intra-operative findings. It is normally performed under general or regional anaesthesia.

How long until I know whether it worked?

It usually takes 3 to 6 months for sperm parameters to stabilise. Reliable assessment is only possible after follow-up semen analyses during this period.

Can I freeze sperm before a vasectomy?

Yes. Sperm can be cryopreserved before a vasectomy and stored long-term for later assisted reproduction (IVF/ICSI). This option must be planned and arranged before the vasectomy.

Conclusion

A vasovasostomy is technically feasible, but it is not a procedure with a guaranteed outcome. The longer ago the vasectomy, the more likely it becomes that patency and pregnancy chances decline. Anyone considering a vasectomy should see it as a long-term decision. Anyone considering a reversal should consult a urologist with specific expertise in andrology and microsurgery and obtain a realistic, individualised forecast.

Book an appointment

Do you have questions about vasectomy or about the possibility of a reversal? We are happy to discuss your individual situation in a confidential consultation at UROMED Vienna.

• Online: uromed.at/en/vasektomie
• Phone: +43 1 353 44 14
• Address: Neubaugürtel 47, 1150 Vienna

All public and private insurances welcome.